Flexible surgical instrument

ABSTRACT

A flexible surgical instrument is provided which is ideal for providing flexibility in surgery performed through a small incision, such as arthroscopic surgery. In one embodiment, the surgical instrument is provided with an outer member having at least one opening in a distal region and a hollow inner member disposed within the outer member for transmitting force applied to the proximal end to move a cutting implement disposed at the distal end. The cutting implement is constructed and adapted to perform a cutting function at the opening in the outer member. The hollow inner member is substantially flexible between its proximal and distal ends. The outer member is provided with a predetermined flexibility and rigidity such that the outer member is provided with sufficient flexibility to be manually bent by a surgeon during and operation, and provided with sufficient rigidity to retain such bend during the continued performance of the operation with the surgical instrument.

CROSS REFERENCE TO RELATED APPLICATION

This application is a division of application No. 08/008,918, filed Jan.26, 1993, which is now U.S. Pat. No. 5,553,416.

BACKGROUND OF THE INVENTION

This invention relates to a surgical instrument, and in particular toflexible arthroscopic surgical instruments.

Arthroscopic surgical instruments typically include a rigid outer tubewithin which a rigid inner tube is rotated by a motor. A cuttingimplement, such as a blade or abrading burr, is disposed on the distalend of the inner tube. Tissue or bone is exposed to the cuttingimplement through an opening in the distal end of the outer tube, andtissue or bone fragments cut by the rotating blade or burr are drawnthrough the interior of the inner tube along with irrigating fluid bythe use of suction applied at the proximal end of the instrument.Examples of such surgical instruments are described in U.S. Pat. Nos.4,203,444--Bonnell et al.; 4,274,414--Johnson et al.; and4,842,578--Johnson et al.

In some instruments, the cutting implement is a hinged jaw mounted atits distal end, and is actuated by hand proximally with the interveningshaft being straight and rigid or rigid with a predetermined bendinstalled at the time of manufacturing.

The aforesaid typical arthroscopic surgical instruments are linear, orin other words, straight between their proximal and distal ends. Suchlinear or straight instruments have limitations and disadvantages inmany surgical operations, as most body parts and cavities of humans andanimals are not straight, but have curved and/or irregular surfaces. Ithas been recognized that it is sometimes useful for such instruments tobe curved to facilitate positioning the cutting implement against thetissue, bone or cartilage to be cut. Accordingly, more recently,arthroscopic surgical instruments have been developed which have a fixedbend or curve placed in the rigid outer tube at the time of fabricationof the instrument. Examples of such instruments with such fixed bends orcurves in the rigid outer tube are described in U.S. Pat. Nos.4,646,738--Trott and 5,152,744--Krause et al. Both of these patentsdisclose a rigid outer tube with a predetermined bend therein which isplaced and fixed in the instrument at the time of fabrication of theinstrument. At least a portion of the inner tube for transmitting torqueto the cutting blade is made flexible such that it freely rotates withinthe bend in the outer rigid tube.

SUMMARY OF THE INVENTION

The present invention provides a greater degree of flexibility in theperformance of surgical procedures in a body cavity through a smallincision. This instrument provides the surgeon with greater flexibilitywherein surgical procedures may be performed more easily and moreaccurately with less discomfort to the patient. This enables the surgeonto more quickly and effectively perform the surgery, and enables moresurgical procedures to be performed more effectively under localanesthesia. The instrument provides greater flexibility in any of thesurgical procedures now commonly performed through a small incision,such as laparoscopic surgery, gynecological surgery performed vaginally,colonoscopic surgery and particularly arthroscopic surgery where it isoften necessary for the instrument to be accurately placed in the curvedspaces between the bones of the joint.

In accordance with the method and apparatus of the present invention,greater flexibility is provided to the surgeon by enabling the surgeonto insert the instrument of the present invention into the body cavity,such as a joint, and visualize by means of a scope (such as thearthroscope, which may or may not be connected to a video display) thenature and location of the bend or curve to be placed in the instrument.The surgical instrument is provided with markings on the length of theinstrument which enables the surgeon to note the precise location of thedesired bends. The surgeon may then remove the instrument, make thenecessary bends in the instrument and reinsert the instrument into thebody cavity, such as the joint.

Accordingly, in accordance with the present invention, the surgicalinstrument is constructed for insertion into the body for cutting,wherein it includes an outer member having at least one opening in adistal region. The surgical instrument includes a hollow inner memberdisposed within the outer member for transmitting force applied to aproximal end to move a cutting implement disposed at the distal end. Thecutting implement is constructed and adapted to perform a cuttingfunction at the opening in the outer member. The hollow inner member isflexible between its proximal and distal ends, and the outer member isprovided with a predetermined flexibility and rigidity such that theouter member is provided with sufficient flexibility to be manually bentby a surgeon during the operation, and provided with sufficient rigidityto retain such bend during the continued performance of the operationwith the surgical instrument.

The method includes the steps of the surgeon inserting the instrumentinto the body, noting the location of the desired bends by observing theindicia on the outer surface of the outer member, retracting theinstrument, performing the bends at the desired location and reinsertingthe instrument for the continued performance of the surgery.

BRIEF DESCRIPTION OF THE DRAWINGS

For the purpose of illustrating the invention, there are shown in thedrawings forms which are presently preferred; it being understood,however, that this invention is not limited to the precise arrangementsand instrumentalities shown.

FIG. 1 is a side view, partially broken away in cross-section, of aflexible surgical instrument in accordance with the present invention.

FIG. 2 is an exploded view of the distal end, partially incross-section, of a flexible surgical instrument in accordance with thepresent invention.

FIG. 3 is a cross-sectional view taken along line 3--3 of FIG. 2.

FIG. 4 is an elevation view of a flexible surgical instrument initiallystraight, then with a single bend and then with a double bend therein.

FIG. 5 is an illustration of a side view of two different prior artdevices utilized in surgical procedures.

FIG. 6 is a side view of a flexible surgical instrument in accordancewith the present invention utilized in a surgical procedure.

FIG. 7 is a side view of another illustration of the present inventionutilized in two different positions in a surgical procedure, one of thembeing shown in dotted outline form.

FIG. 8 is a plan view, partially broken away, of a manually operatedflexible surgical instrument in accordance with the present invention.

FIG. 8A is an exploded view of the portion of the instrument asindicated in FIG. 8 wherein a portion thereof is shown in cross-section.

FIG. 9 is a plan view of another embodiment of a flexible surgicalinstrument in accordance with the present invention.

FIG. 10 is a view in cross section of an alternate embodiment of outertubular member 14.

FIG. 11 is a cross-sectional view of another embodiment of the structureof outer member 14.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

Referring now to the drawings in detail, wherein like numerals indicatelike elements, there is shown in FIG. 1 a flexible surgical instrument10 in accordance with the present invention. The surgical instrument 10is intended and adapted to be utilized with a hand-held motor unit whichis controlled by a foot pedal or other similar switching device which iswell known in the field of arthroscopic surgery. For example, a motorand a foot pedal of one suitable type is shown and described in U.S.Pat. No. 4,705,308--Sjostrom et al. The surgical instrument 10 isutilized in surgical procedures such as those which utilize surgicalincisions at a joint for a fluid source, a scope connected to a cameraand a hand-held motorized unit with a vacuum source, as illustrated anddescribed generally in U.S. Pat. Nos. 4,203,444--Bonnell et al. and5,152,744--Krause et al. Although a video scope connected to a monitorfor use as a video display is generally presently preferred, it isunderstood that the present invention may be utilized with any type of ascope or viewing device.

The present invention provides the improvement wherein the entire lengthor substantially the entire length of the portion of the instrument 12which may be inserted into the body for cutting is provided with apredetermined flexibility and rigidity such that its shape may beadjusted during the surgical procedure by the surgeon with the length 12retaining this shape, curvature or bend for as long as is desired duringthe surgical procedure. The portion of the instrument 11, to the rightof flexible length 12 in FIG. 1, is adapted to be inserted in orotherwise installed in a hand-held motorized handpiece which has asuction connection of one type conventionally available today. It isunderstood that the structure of portion 11 may be varied to be receivedin other types of hand-held motorized units.

The flexible length 12 is comprised of an outer member or outer tube 14and a hollow inner member or inner tube 16. The inner member 16 ishollow to enable the passage of fluid and tissue that has been cut to bewithdrawn from the cutting area by suction or a partial vacuum. As usedherein, the term "tissue" is understood to mean broadly all componentsof the body made up of cells and intercellular material, including notonly soft tissue but also cartilage and bone.

Outer member 14 may be constructed of any suitable material whichprovides sufficient flexibility and rigidity such that outer member 14may be bent manually by the surgeon during the surgical procedure, andwith sufficient rigidity such that the bend placed in outer member 14 isretained during the surgical procedure for so long as desired, withsufficient rigidity to maintain its shape and withstand the forcesnormally applied to it during such surgical procedures. Outer tube orouter member 14 may be constructed of a titanium alloy or a suitableplastic having memory. Outer member 14 may be ribbed or recessed similarto that shown in FIG. 10, or may be a bellows structure similar to thatshown FIG. 11.

The inner member 16 may be constructed of any suitable material whichprovides sufficient flexibility to enable it to freely rotate withinouter member 14, while having sufficient strength to transmit the forcesfrom the proximal end 18 to the distal end 20. Inner member 16 must haveflexibility along its length coextensive with the flexibility in outermember 14. Preferably, outer member 14 is flexible along its entirelength or substantially its entire length, and accordingly, in apreferred embodiment, inner member 16 would be flexible along its entirelength. Inner member 16 may be constructed of any suitable flexiblematerial, such as a flexible plastic, or may be constructed ofstructures such as those illustrated for a portion of the inner tubularmember in U.S. Pat. Nos. 4,646,738--Trott and 5,152,744--Krause et al.

A cutting implement 22 is disposed at the distal end 20 attached tohollow inner member 16 as illustrated in FIG. 2 by any suitableconnection. As shown therein, the cutting implement 22 and inner member16 may be form-fitted and adhesively bonded together at 17.

Referring now to FIG. 4, there is shown an insertable flexible length 12of an instrument with markings or indicia on its outer surface. Themarkings shown in FIG. 4 are the numerals 1 through 13. These may bearbitrarily placed on the instrument, or they may represent centimetersof length or other units of measurement. Further, the indicia may be anysuitable indicia, including letters or other arbitrary symbols ormarkings of any type. Markings on the outer surface of outer member 14are utilized to enable a surgeon to view and identify at what pointalong the length of insertable instrument the bend should be placed.

As illustrated in FIG. 4, 12 represents a straight insertable lengthbefore bending, 12a represents the insertable length wherein a bend hasbeen placed at approximately the location marked between the indicia 5and 6. In a similar manner, the insertable length 12b illustrates thebend at the location between 5 and 6, and a more rounded bend locatedapproximately at the 10-11 marking. It is understood that bends may beplaced at any location along the length 12 as so desired by the surgeon.

Multiple bends of any type or location may be placed in the length ofthe insertable instrument 12. For example, as illustrated in FIG. 1,there are bends at 24, 25 and 26.

FIG. 5 illustrates two types of prior art instruments being utilized toperform a cutting function at an arcuatly shaped bone 28. Instrument 30is a rigid straight instrument which presents problems, and instrument32 represents a rigid instrument with a fixed curve, such as thatillustrated in U.S. Pat. No. 5,152,744, which again places limitationson the surgical procedure due to the fact that it has a single fixedcurve which cannot be adjusted during the surgical procedure.

Referring now to FIG. 6, there is shown an instrument utilized inaccordance with the present invention wherein the outer member 12 may beshaped during the surgical procedure to go around the curved bone 28.

FIG. 7 illustrates an implement in accordance with the present inventionwherein the instrument may have two oppositely directed curves to enableit to be inserted through a single incision to reach various locations.In FIG. 7, there is a curve at 30 in one direction and a curve in theopposite direction at 32. The curves are of different radii ofcurvature. The present invention provides ultimate flexibility inshaping or curving the length of instrument 12 to that as desired duringthe surgical operation. The joints, bones and body cavities of differentpeople are different. Accordingly, no one preset curvature is ideal forall operations on all people and animals. FIG. 7 also illustrates indotted outline form wherein the instrument may be removed and rotated toaccess the other side of bone 28 or, alternatively, the instrument maybe reshaped.

Referring now to FIGS. 8 and 8A, there is shown a manually operableinstrument 40 provided with a flexible length of insertable instrument42. The outer member or outer tube 44 is provided with a sufficientdegree of flexibility between its proximal end 48 and its distal end 50to enable it to be manually bent or shaped by a surgeon during anoperation, and with sufficient rigidity to retain such bend during thecontinued performance of the operation. As may be seen best in FIG. 8A,within outer member 44 is an inner member 46 which may be a rod whichprovides the transmission of force between the handles 52 and thecutting implement 54. The inner member 46 may also be a solid or hollowflexible inner member which may transmit the force to cutting implement54 by rotation.

As illustrated in FIG. 8, instrument 40 is provided with a bend at 56. Asecond bend is shown in dotted outline form at 58. Any suitable bend maybe provided to the instrument shown in FIG. 8. As may be seen in FIG.8A, the outer surface of outer member 44 may be provided with indicia,such as the letters 45 illustrated in FIG. 8A, or any other suitablemarkings which may be utilized to aid in viewing the desired location ofbends via the scope. The indicia, as stated above, may be numerals orline markings which may or may not be graduated.

Referring now to FIG. 9, there is shown another embodiment of a manuallyoperable instrument 60. Instrument 60 is provided with a length ofinsertable element 62 which has sufficient flexibility and rigidity suchthat element 62 may be manually bent by the surgeon during theoperation, and has sufficient rigidity to maintain such bend orcurvature during the operation for so long as desired. Element 62 iscomprised of two slidable elements 62a and 62b. The force is transmittedfrom handle 72 at the proximal end 68 to cutting implement 74 at distalend 70. As illustrated in FIG. 9, the insertable length 62 is providedwith a curve or bend at 76, and another possible bend at 78. The outersurface of member 62 (actually either or beth the outer surfaces of 62aand 62b) may be provided with suitable indicia to aid in locating viathe scope the desired location of bends to be placed as described withrespect to beth FIGS. 8A and FIG. 4.

The insertable portions 42 and 62 of the instruments of FIGS. 8 and 9would preferably be supplied without any bends, or in other words,straight. Bends 56 and 58 illustrated in FIG. 8 and bends 76 and 78illustrated in FIG. 9 are preferably those which may be manually placedinto the instrument during the surgical procedure. Alternatively, one ormore bends might be provided in the instrument as manufactured.

Although a presently preferred embodiment of the surgical instrument isfor the entire insertable portion 12 to be flexible, it is understoodthat variations may be made wherein less than the entire length ofmember 12 is flexible. Where less than the entire insertable portion ofthe instrument is to be made bendable during the surgical procedure,this may be accomplished by either a change in the composition of thematerial or by the providing of a union wherein a portion of the lengthis rigid and another portion has the desired degree of flexibility. Itwill be apparent that other changes and modifications may be made to thesurgical instrument within the scope and spirit of the presentinvention.

In view of the foregoing, the present invention may be embodied in otherspecific forms without departing from the spirit or essential attributesthereof and, accordingly, reference should be made to the appendedclaims, rather than to the foregoing specification as indicating thescope of the invention.

I claim:
 1. A surgical instrument that is constructed for insertion intoa body for cutting, comprising:an outer member of a predetermined lengthhaving at least one opening in a distal region thereof; a hollow innermember disposed within said outer member for transmitting force appliedto a proximal end to rotationally move a cutting implement disposed at adistal end, said cutting implement being constructed and adapted toperform a cutting function at said opening in said outer member; andsaid hollow inner member being constructed of a flexible plastic andbeing flexible substantially between its proximal and distal ends, saidhollow inner member with said cutting implement attached extending forsubstantially the entire length of said outer member, and said outermember being provided with a predetermined flexibility and rigidity suchthat said outer member is provided with sufficient flexibility to bemanually bent after manufacture by a surgeon during an operation, andprovided with sufficient rigidity to retain such bend during thecontinued performance of the operation with the surgical instrumentwherein said hollow inner member and said outer member are capable ofbeing bent as a unit at any point between said cutting implement andsubstantially said proximal end.
 2. The instrument of claim 1 whereinsaid outer member is provided with markings on an outer surface of saidmember extending substantially along its entire length.
 3. A surgicalinstrument that is constructed for insertion into a body for cutting,comprising:an outer hollow member having at least one opening in adistal region thereof; an inner hollow member disposed within said outermember for transmitting force applied to a proximal end to move acutting implement disposed at a distal end, at least a portion of saidinner member being flexible, said portion of said inner member beingconstructed of flexible plastic, said cutting implement beingconstructed and adapted to perform a cutting function at said opening insaid outer member; a portion of said outer member being provided with apredetermined flexibility and rigidity such that said outer member isprovided with sufficient flexibility to be manually bent by a surgeonduring an operation, and provided with sufficient rigidity to retainsuch bend during the continued performance of the operation with thesurgical instrument; and the portion of said outer member provided witha predetermined flexibility and rigidity and said flexible portion ofsaid inner member being coextensive.
 4. The instrument of claim 3wherein said inner member is flexible substantially from its proximalend to its distal end and wherein said outer member is provided withsaid predetermined flexibility and rigidity substantially from saidproximal end to said distal end.
 5. The instrument of claim 3 whereinsaid outer member is provided with markings on an outer surface of saidmember extending substantially along its entire length.
 6. A surgicalinstrument that is constructed for insertion into a body for cutting orgrasping, comprising:an outer member having at least one opening in adistal region thereof; a flexible inner member disposed within saidouter member for transmitting force applied to a proximal end to move acutting or grasping implement disposed at a distal end, said innermember being constructed of flexible plastic, said implement beingconstructed and adapted to perform a cutting or grasping function atsaid opening in said outer member; and said outer member being providedwith a predetermined flexibility and rigidity such that said outermember is provided with sufficient flexibility to be manually bent by asurgeon during an operation, and provided with sufficient rigidity toretain such bend during the continued performance of the operation withthe surgical instrument.
 7. The instrument of claim 6 wherein said outermember is provided with markings on an outer surface of said memberextending substantially along its entire length.
 8. A surgicalinstrument that is constructed for insertion into a body for cutting orgrasping, comprising:a first member provided with a cutting or graspingimplement disposed in a distal region thereof; a second member mountedto and slidably movable with respect to said first member, said secondmember being adapted for transmitting a force applied to a proximal endto move the cutting or grasping implement disposed at a distal end, saidimplement being constructed and adapted to perform a cutting or graspingfunction at said distal end; and each of said first and second membersbeing provided with a predetermined flexibility and rigidity such thatsaid first and second members are provided with sufficient flexibilityto be manually bent by a surgeon during an operation, and provided withsufficient rigidity to retain such bend during the continued performanceof the operation with the surgical instrument.
 9. The instrument ofclaim 8 wherein at least one of said first and second members isprovided with markings on a surface of said member extendingsubstantially along its entire length.
 10. An endoscopic blade,comprising:a hollow outer member of a predetermined length having anopening in a distal region thereof; a rotatable hollow inner memberdisposed within said outer hollow member for transmitting a rotationalforce applied to a proximal end to rotationally move a cutting implementdisposed at a distal end, said cutting implement being constructed andadapted to perform a cutting function at said opening in said outermember; said hollow inner member being constructed of a flexible plasticmaterial and being flexible substantially between its proximal anddistal ends, said hollow inner member with said cutting implementattached extending for substantially the entire length of said outermember; and said outer member being provided with a predeterminedflexibility and rigidity such that said outer member is provided withsufficient flexibility to be bent after manufacture by a surgeon duringan operation, and provided with sufficient rigidity to retain such bendduring the continued performance of the operation with the surgicalinstrument wherein said endoscopic blade is capable of being bent at anypoint between said cutting implement and substantially said proximalend.
 11. An endoscopic blade in accordance with claim 10 wherein saidhollow outer member is provided with markings on an outer surface ofsaid member.
 12. An endoscopic blade in accordance with claim 11 whereinsaid markings on said outer Surface of said member extend substantiallyalong said hollow outer member from a proximal region to said opening insaid distal region.